EKG in Acute Pulmonary Embolism

The sensitivity and specificity for EKG findings in acute PE are low.

EKG is helpful in evaluating for other causes of cardio-pulmonary symptoms + supporting evidence of PE

Increased Adrenergic Drive:

 • Sinus Tachycardia (most common finding)

 • Atrial Arrhythmia* (e.g., A-Fib also a result of atrial stretch)

RA/RV Dilation:

 • Incomplete or Complete RBBB (RBB prone to stretch especially early in its course)

 • Right Axis Deviation

 • Dominant R Wave in V1

 • Shift of Precordial Transition Point to V5 (as RV "rotates" with dilation in relation to ECG leads)

RV Ischemia or Strain:

 • S1-Q3-T3 (not a sensitive finding)

 • TWI in Right Precordial Leads (VI-V3) +/- Inferior Leads

 • Non-specific ST-T Changes

 • STE in aVR +/- Right Precordial Leads



- Karan Desai MD @karanpdesai via CardioNerds @cardionerds



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